Monday, March 17, 2008

Psychoanalyzing medical bloggers on NPR’s Morning Edition

The program featured Kevin MD, and Robert Wachter along with psychiatrist and psychoanalyst Deborah Peel. Dr. Peel thinks it’s inappropriate for medical bloggers to vent their frustrations on line. Here’s what Wachter had to say about her comments:

…personally I thought the psychiatrist went a bit overboard when she said,

"If you are unhappy with the people that you're supposed to be serving and taking care of, you probably need therapy," she says. "You don't need to be venting your frustrations in a public manner like that. That's very inappropriate and unprofessional."

Re-read my last post on resuscitating 90-year-olds with metastatic cancer and dementia. Do I need a head shrinker?

No Bob, you don’t, but maybe Dr. Peel needs to work a few shifts in an ER or spend a few sleep deprived call nights on a busy medicine service.

3 comments:

Deborah C. Peel, MD
said...

I actually was a paid supervisor in the Emergency Room at the UTMB Galveston during the last year of my residency. I also freelanced as an emergency room doctor during my residency in cities near Galveston. I certainly understand the stresses and frustrations that occur in emergency rooms. I have been there.

But again, airing complaints or writing hostile or unflattering comments about people who you have treated in a public forum where they can easily identify themselves or others can identify them is extremely unprofessional.

It violates your patients' privacy, it is a betrayal of the Hippocratic Oath and medical ethics, it is hurtful to those patients, and more broadly destroys the public's trust in physicians and in you. Aren't those enough reasons to stop blogging about your patients?

There are professional forums for talking about and dealing with problems you experience with patients, such as supervision or consultation with senior colleagues or private discussions with trusted colleagues. These are standard practices in psychiatry and psychoanalysis.

Physicians who have mental health training typically learn a great deal about how their personal views of other people are not neutral and can lead to inappropriate responses, from anger to withdrawal to over involvement to identification, etc. Physicians bring their own personalities to the table with everyone they meet, including their patients. It’s really helpful to have some insight into your own personality and biases---that knowledge can help stop you from harming your patients and ensure they get effective treatment.

Our views of our patients are deeply affected by our early relationships, so that when we get very angry or very frustrated by a particular patient, we should take that as a sign of the need to think more deeply about such powerful and hopefully atypical responses.

If you are a physician who has a need to blog about your patients, you really should consider professional help. New technology does not mean that you no longer have ethical duties to your patients; in fact, it means that your ethical duties need to be translated into the new Digital arena.

And if you lack the ability to empathize with your patients and to understand why their behavior bothers you, you really do need therapy, or you should change professions. It is critical to be able to put yourself in someone else's shoes to be able to effectively treat them.

Well, Dr. Peel, I appreciate the fact that you've spent some time in the ER.

I agree with you in general although I thought your generalization about bloggers needing therapy was a little strong. Perhaps we could all benefit to one degree or another from training to gain insight about our personalities and how these intrinsic factors shape our reactions to patients, and in that very broad sense maybe we all need therapy.

The way it came across on the NPR piece, however, was somewhat more negative. If a doctor expresses frustration and anger is it psychopathology or just being human? We all have our individual thresholds. An angry doctor may need therapy. Just as likely he/she may need more sleep, better hours, more time to spend with each patient, or more time with family. Who knows?

Blogging about such frustrations is problematic. I personally don't blog about individual patients or local issues. But I believe most bloggers who talk about patients disguise their presentations enough to preserve privacy.

When I read an angry post about a patient I have no way to verify whether the disguise is adequate, do you? But I'm sure most medical bloggers are at least smart enough about the HIPAA risks to remove all clues to the identity of the patient.

Dr. Peel jumps to the conclusion that the patients being described are individuals and not composites, that they are easy to identify and that the information about the patients has not been changed to make identification essentially impossible.

I dare Dr. Peel to identify any patient from my site. I have been using the pseudonym "Deborah Peel" for all of my patients and for some of my coworkers since her appearance on NPR.

How does a physician mass diagnose people without ever meeting them?

How does a physician prescribe treatment to people based on that fraudulent diagnosis?

Medical professionalism is completely absent from her behavior, yet she accuses others of being unprofessional and inappropriate.

Where does she find any evidence that blogs are any more of a threat to patient privacy than medical books?

House of God, MASH, Awakenings, ...

There are many books that have been written on medical topics that do not always put the patient in the best light. Where is her outrage?

Where is the concern for the privacy of these patients?

Perhaps she does not read books and is unaware of the phenomenon of bound volumes of printed pages compiled for entertainment or even education.

What about television?

ER has all sorts of information about patients and - horrors - you can see the patients (maybe she does not know they are only actors).

Imagine if any of those patients were to watch the TV show and recognize their own medical case being portrayed on screen.

If you want less than positive portrayals of patients and staff, what about House, MD?

She probably does not understand the sarcasm.

Dr. Deborah Peel should be reported to the state medical board for her on air medical malpractice. She should also be continuously ridiculed for her blatant hypocrisy.

Or, maybe I am wrong and she is the answer to all of the world's problems.